ORLANDO -- When it comes to providing key care for heart attacks, heart failure and pneumonia, most Orlando-area hospitals are on the sick list, according to new federal data just released by the Centers for Medicaid and Medicare Services.

The treatments include: giving heart attack patients aspirin and beta blockers on arrival and at discharge; and giving elderly pneumonia patients a pneumococcal vaccination before discharge if they haven't had one before.

The purpose of the report is to help consumers decide which hospitals have the best quality of care. Hospitals voluntarily reported the information to Medicare. The data, from the first three months of 2004, now are available in a report --www.cms.hhs.gov/quality/hospital/ -- on the Web.

Some hospital officials, meanwhile, argue the information is outdated and many issues were corrected months ago.

Others say quality of care isn't the problem, but rather, getting doctors and nurses to write down the treatments, and to do so in a consistent manner. For example, some doctors don't write it down in a patient's chart when they give aspirin because it's not a prescription drug.

"The primary issue we are seeing is with documentation by patient care providers," says Johnette Gindling, a spokeswoman for the Wuesthoff Health System, which has two low-scoring hospitals in Central Florida.

Taking corrective action

In the Orlando area, Florida Hospital -- long known as the area's premier heart-care facility -- as well as Central Florida Regional Hospital in Sanford, Health Central in Ocoee and Osceola Regional Medical Center in Kissimmee mostly scored below half of 4,000 other hospitals across the nation submitting data for heart attack, heart failure and pneumonia treatments.

But reading the report isn't a valid way to choose a hospital, say some hospital officials.

Mark Cobia, spokesman for Health Central, contends the information in the report is almost a year old, and when his hospital collected the data to submit to Medicare, "we discovered the deficiencies in our protocols and took steps to correct that back then. The data just hasn't caught up to reflect that yet."

And, points out Dr. Lee Adler, Florida Hospital's medical director for clinical performance improvement, "We have a 50 percent lower mortality rate for ICU patients with heart attacks than any other hospital in the nation."

Leonard also adds that the Medicare report looks at how many heart attack patients are given an ACE inhibitor, but today, many top cardiologists use a different, superior alternative that Medicare just began recognizing this year.

The Orlando area's one standout hospital? Orlando Regional Medical Center, which scored in the top 50 percent nationally for five of seven heart attack and heart failure care treatments. But, like most local hospitals, that facility scored in the bottom 50 percent for pneumonia care.

Outlying counties

Farther afield in Central Florida, only two hospitals -- South Lake Hospital in Clermont and Bert Fish Medical Center in New Smyrna Beach -- scored well for heart attack, heart failure and pneumonia care.

South Lake scored in the top 10 percent of hospitals nationwide for all the heart attack and heart failure treatments, and in the top half of U.S. hospitals for two of three pneumonia treatments. And Bert Fish Medical Center scored in the top 10 percent for one of the heart attack categories and scored in the top half of U.S. hospitals for four other heart attack and heart failure treatments, as well as for two of three pneumonia treatments.

Wuesthoff's Gindling says some hospitals struggle to accurately document simple treatments, even though they are provided. "Hospitals document the care given to patients differently, and the differences in documentation make true comparisons difficult."

Halifax spokesman John E. Evans attributes his facility's poor scores to mistakes in its data submission. "The way the data was submitted has tended to skew the results," Evans says. "We think our record is better than the results indicate and it will begin to show up when the next couple of reports come out."

Likewise, Renee McCullough, director of professional services at Florida Hospital DeLand, says the report doesn't accurately reflect the quality of service provided.

"It's still a work in progress," she says.

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